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Nguyen L.H.,Vietnam National University, Hanoi | Phan H.T.T.,Authority of HIV AIDS Control
PLoS ONE | Year: 2015

Patient satisfaction is an important component of quality in healthcare delivery. To inform the expansion of Methadone Maintenance Treatment (MMT) services in Vietnam, we examined the satisfaction of patients with regards to different services delivery models and identified its associated factors. © 2015 Tran et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source

Tran B.X.,University of Alberta | Nguyen L.T.,Authority of HIV AIDS Control
International Journal of Drug Policy | Year: 2013

Background: This study assessed the impact of methadone maintenance treatment (MMT) on health utility, health care service utilization, and out-of-pocket (OOP) health expenditure in drug users with HIV/AIDS in Vietnam. Methods: Using the 2012 Vietnam HIV Service Users Survey data, a post-evaluation was designed to compare 121 MMT patients with 347 non-MMT patients who were matched using propensity scores of MMT covariates. Health utility was measured using the EuroQOL - five dimensions - five levels (EQ-5D-5L) and a visual analogue scale (EQ-VAS). Results: The mean EQ-5D-5L single index and EQ-VAS score of MMT patients were 0.68 (95% CI=0.64-0.73) and 71.5% (95% CI=68.2-74.9). Compared with the control group, the adjusted differences in health utility were 0.08 and 4.43% (p=0.07), equivalent to 12.1% and 6.5% increases during MMT. There was a 45.9% decrease in the frequency of health care service utilization that was attributable to MMT. Although, antiretroviral treatment and MMT services were free-of-charge, MMT and non-MMT patients still paid their OOP for health care for averagely US$ 16.3/month and US$ 28.9/month. The adjusted difference between the two groups was US$ 19.3/month ($ 231.6/year) that equivalents to a reduction of 66.7% in OOP health expenditure related to MMT. Conclusion: MMT was associated with a clinically important difference in health utility, large reductions in health care service utilization and OOP health expenditure in HIV-positive drug users. Scaling up MMT in large drug-using population could help improve the outcomes of HIV/AIDS interventions and reduce economic vulnerability of affected households. © 2013 Elsevier B.V. Source

Tran B.X.,Johns Hopkins University | Nguyen L.H.,Hanoi Medical University | Phan H.T.T.,Authority of HIV AIDS Control | Nguyen L.K.,Illinois Wesleyan University
Harm Reduction Journal | Year: 2015

Background: Integrating and decentralizing services are essential to increase the accessibility and provide comprehensive care for methadone patients. Moreover, they assure the sustainability of a HIV/AIDS prevention program by reducing the implementation cost. This study aimed to measure the preference of patients enrolling in a MMT program for integrated and decentralized MMT clinics and then further examine related factors. Methods: A cross-sectional study was conducted among 510 patients receiving methadone at 3 clinics in Hanoi. Structured questionnaires were used to collect data about the preference for integrated and decentralized MMT services. Covariates including socio-economic status; health-related quality of life (using EQ-5D-5L instrument) and HIV status; history of drug use along with MMT treatment; and exposure to the discrimination within family and community were also investigated. Multivariate logistic regression with polynomial fractions was used to identify the determinants of preference for integrative and decentralized models. Results: Of 510 patients enrolled, 66.7 and 60.8% preferred integrated and decentralized models, respectively. The main reason for preferring the integrative model was the convenience of use of various services (53.2%), while more privacy (43.5%) was the primary reason to select stand-alone model. People preferred the decentralized model primarily because of travel cost reduction (95.0%), while the main reason for not selecting the model was increased privacy (7.7%). After adjusting for covariates, factors influencing the preference for integrative model were poor socioeconomic status, anxiety/depression, history of drug rehabilitation, and ever disclosed health status; while exposure to community discrimination inversely associated with this preference. In addition, people who were self-employed, had a longer duration of MMT, and use current MMT with comprehensive HIV services were less likely to select decentralized model. Conclusion: In conclusion, the study confirmed the high preference of MMT patients for the integrative and decentralized MMT service delivery models. The convenience of healthcare services utilization and reduction of geographical barriers were the main reasons to use those models within drug use populations in Vietnam. Countering community stigma and encouraging communication between patients and their societies needed to be considered when implementing those models. © 2015 Tran et al. Source

Tran B.X.,Hanoi Medical University | Nguyen L.T.,Authority of HIV AIDS Control | Hoang Q.V.,Hanoi Medical University | Hwang J.,University of Alberta
Global Health Action | Year: 2013

Introduction: Adherence to antiretroviral treatment (ART) is vital in achieving virological treatment success. This study assessed the prevalence of optimal ART adherence and its determinants among HIV/AIDS patients in Vietnam. Method: A cross-sectional survey was conducted with 1,016 HIV/AIDS patients at seven hospitals and health centers providing antiretroviral treatment services in three provinces, including Hanoi, Hai Phong, and Ho Chi Minh City. Self-reported medication adherence was measured using a 30-day visual analog scale (VAS) and 7-day missed-doses questions. Results: The mean adherence VAS-score was 94.5 out of 100 (SD=8.2), ranging from 40 to 100%. The rate of suboptimal adherence was 25.9%. The rate of missed-doses was 25.2%. In multivariate analysis, increased perceived self-efficacy, use of mobile phone alarms, and reminders from family members were associated with optimal adherence; higher CD4 level, single status, and unstable employment were associated with suboptimal adherence. Conclusion: High rate of suboptimal adherence observed in this study highlights the importance of adherence support interventions during ART. The use of mobile phone reminders, involvement of relatives, and HIV self-management training programs have the potential to improve ART adherence in Vietnam. © 2013 Bach Xuan Tran et al. Source

Nguyen L.T.,Authority of HIV AIDS Control | Tran B.X.,Hanoi Medical University | Tran C.T.,Authority of HIV AIDS Control | Thi Le H.,Authority of HIV AIDS Control | Van Tran S.,Authority of HIV AIDS Control
ClinicoEconomics and Outcomes Research | Year: 2014

Introduction: Antiretroviral treatment (ART) services are estimated to account for 30% of the total resources needed for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) control and prevention in Vietnam during the 2011-2020 timeframe. With international funding decreasing, determining the total cost of HIV/AIDS treatment is necessary in order to develop a master plan for the transition of ART services delivery and management. We analyzed the costs of HIV/AIDS treatment paid by both HIV programs and patients in a central outpatient clinic, and we explored factors associated with the capacity of patients to pay for this service. Methods: Patients (n=315) receiving ART in the Department of Infectious Diseases at Bach Mai Hospital, Hanoi, Vietnam, were interviewed. Patient records and expenses were reviewed. Results: The total cost of ART per patient was US$611 (75% from health care providers, 25% from patients or their families). The cost of a second-line regimen was found to be 2.7 times higher than the first-line regimen cost. Most outpatients (73.3%) were able to completely pay for all of their ART expenses. Capacity to pay for ART was influenced by five factors, including marital status, distance from house to clinic, patient's monthly income, household economic condition, and health insurance status. Most of the patients (84.8%) would have been willing to pay for health insurance if a copayment scheme for ART were to be introduced. Conclusion: This study provides evidence on payment capacity of HIV/AIDS patients in Vietnam and supplies information on ART costs from both provider and patient perspectives. In particular, results from this study suggest that earlier access to ART after HIV infection could dramatically reduce the overall cost of treatment. © 2014 Nguyen et al. Source

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